(5) Traumatic Brain Injury Flashcards by Peter Ford

What are the most common acquired brain injuries?

Stokes
Road accidents
Falls
Tumour
Assault

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What is traumatic brain injury?

An insult to the brain by an external physical force that may produce a diminishes or altered state of consciousness, which results in impairment of physical abilities and/or cognitive function.

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What is a contrecoup injury?

Are head injuries that most often involve cerebral contusions and traumatic subarachnoid hemorrhage

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What is cerebral concussion?

Shaking of the brain
Brief loss consciousness
Headache
Dizziness
Amnesia

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What is cerebral contusion?

Bruise
Small haemorrhage

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What is cerebral laceration?

Tear of cortical surface with contusion

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What are the two types of impact damage to the brain?

Cortical contusions and lacerations associate with haemorrhage
Diffuse axonal injury involves shearing of axons causing disruption of nerve impulses

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What are the different types of secondary brain damage?

Intracranial haematoma
Cerebral swelling
Tentorial or tonsillar herniation
Cerebral ischaemia
Infection

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What types of haemorrhage occur post TBI?

Epidural
Subdural
Intracerebral

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What is brain death?

Is when the entire brain, including the brain stem has irreversibly lost function

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What are normal vs negative pupil responses?

Normal the pupil constricts to light
Negative there is no change in pupil size

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What are tests to determine brain death?

Pupil response
Corneal reflex
Absence of VOR
Pain test
Anoxia test

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What is the brain death procedure?

Carried out by two doctors both with expertise
Tests should be repeated 12-24 hours later

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What is cerebral perfusion?

Blood circulating around the brain at sufficient speed and force to maintain sufficient O2

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What is cerebral perfusion influenced by?

Blood pressure
Intracranial pressure

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What can cause cerebral ischaemia?

Hypoxia
Decrease in cerebral perfusion

What is meningitis?

Infection of the meninges

What is cerebral abscess?

Serious infection of the brain where pus pockets full of infected material form

What can lead to infection in the brain?

Dural tear (CSF leak)
Compound depressed fracture
Base of skull fracture

What are the main objective during the acute phase of TBI?

Ensure sufficient blood O2 levels
Maintain cerebral perfusion pressure
Control raised intracranial pressure
Keep blood pressure stable
Prevent secondary brain damage

What are the priorities of assessment for multiple injuries?

Check airways
Breathing (O2 and resp mvmts)
Circulation (pulse and BP)
Chest/abdominal injury
Head/spinal injury (Conscious level)
Limb injury

What is looked for during assessment?

period of loss consciousness
period of post traumatic amnesia
cause and circumstances of injury
headache and vomiting
evidence of injury
pupil response and other cranial nerves
Glasgow coma scale

What is involved in the Glasgow Coma Scale?

Eye opening
Verbal response
Best motor response

How is the severity of the injury decided?

Lowest GCS in first 24 hours
Depth of coma/altered consciousness
Duration of coma

What is post traumatic amnesia?

Period from injury until return of day-to-day memory on a continuous basis

How is the severity of post traumatic amnesia decided?

- Mild < 1hour - Moderate between 1-24 hours - Severe 24 hours to 7 days - Very severe > 7 days

What is the management of TBI in the acute phase?

- Look at ICP and GCS - Maintain good cerebral perfusion - Prevent secondary brain damage - Resp physio as necessary - Maintain muscle length - Good positioning

What does the respiratory treatment in the acute phase involve?

- Maintain good cerebral perfusion - Assess resp status - O2 sats, ICP, BP, CXR, Ausc - Positioning and muscle length - Minimize effects spasticity

What is other treatment during the acute phase when the patient is stable?

- Functional bed mobility - Watch tendon achilles closely for signs shortening - Early standing, sitting - Care of airway & other tubes

What can brain stem swelling/damage lead to?

Rigidity

What are the different stages of recovery?

- Agitation - Aggression - Becoming aware of injuries - Possible depression

What effects does TBI have on motor function?

- Spasticity - Hyperreflexia - Abnormalities of mvmt and posture - Trunk/limb weakness - Tremor - Incoordination - Dysphagia & Dysarthria - Incontinence - Epiliepsy - Fatigue - Heterotrophic ossification

What are some cognitive, behavioural and psychological problems associated with TBI?

- memory - confusion - poor judgement & reasoning - personality changes - disinhibition & impulsiveness - emotional liability - perceptual deficits - depression - language deficits - economic and social impact

What is involved in management of a subacute TBI?

- Thorough assessment - Head control, sitting and standing balance - Problem list - Short and long term goals - MDT N.B

What are the aims of treatment in rehab phase?

- normalise tone - facilitate normal movement - sensory stimulation - communicate with family - restore function - consider effects cognitive problems - restore physical fitness - behavioural modification - continuous evaluation

What are some discharge considerations?

- Home support - Community services - Headway Ireland - Vocational retraining - Long-term neurological difficulties